Zusammenfassung der Ressource
Yellow Eyes
- hepatobiliary system
- The (hepato) part
- The (Biliary) part
- Gallstone impacted in the neck or Hartmann's Pouch
- Mirizzi syndrome
- Having to do with the liver plus the gallbladder, bile ducts, or bile.
- Hemoglobin metabolism
- Hemoglobin Degradation
- Porphyrin ring is opened by oxidation reaction that is
catalysed by the microsomal haem oxygenase, which requires
NADPH and O2.
- The result of this reaction is linear biliverdin, Carbon
monoxide (CO) and release of Fe 3+.
- Biliverdin (green) is reduced forming a red-orange bilirubin
- Bilirubin is relatively insoluble this is why it binds
non covalently to albumin* to be transported to
the liver.
- At the hepatocytes
- Bilirubin dissociates from albumin and binds to an intracellular protein ligandin.
Microsomal bilirubin UDP-glucuronosyltransferase (bilirubin UGT)* conjugate bilirubin
to two molecules of glucuronic acid♠.
- Jaundice
- Prehepatic
- Causes
- Physiologic
Jaundice
- hemolytic anemia
- Gilbert syndrome
- is a relatively mild condition characterized by periods of elevated levels
of a toxic substance called bilirubin in the blood (hyperbilirubinemia)
- Criggler Naggar
- Crigler–Najjar syndrome or CNS is a rare inherited disorder affecting the
metabolism of bilirubin, a chemical formed from the breakdown of the
heme in red blood cells.
- High unconjugted bilirubin
- Normal urine as there is no bilirubin(+++UBG )
- Normal stool(+++UBG )
- Liver enzymes are normal
- conjugated bilirubin (<20%)
- caused by anything which causes an increased rate of hemolysis (breakdown of red blood cells).
- Hepatic
- Causes
- Hepatitis
- Hepatitis B signs and symptoms
- variable fever
- profound malaise
- painful hepatomegaly
- serum sickness prodrome
- vasculitis
- high levels of unconjugated bilirubin
- dark urine due to high levels of Conjugated bilirubin
- Stool color is normal
- Liver enzymes are increased due to damage to the liver
- +Conjugated Bilirubin (20-50%)
- Treatment of HBV
- Lamivudine
- inhibits HBV DNA polymerase
- In renal impairment , dose is adjusted
- Entecavir
- Guanosine monophosphate
- inhibits HBV DNA polymerase
- Pegylated interferons
- Endogenous proteins
- Polyethene glycol is added to make the drug last longer ( once weekly instead of 3 times a week)
- Resistance to viruses
- Inhibit proliferation
- Inhibit multiplication of intracellular parasites
- adefovir
- Phosphorylated by cellular kinases (prodrug )
- inhibits HBV DNA polymerase, causing chain termination
- Nephrotoxicity, lactic acidosis (mitochondrial dysfunction) and hepatic steatosis
- immunization schedule
- Recombinant HepB vaccines containing yeast-derived
- HBsAg Recombivax-HER or Engerix-BR
- Day zero, day 30, 6 months (0-1-6)
- liver inflammation
- Posthepatic
- Causes
- Primary biliary cirrhosis
- Dubin-Johnson
- Rotor’s syndrome
- Gall stones in CBD
- pancreas head cancer
- Primary sclerosing cholangitis
- Extrahepatic biliary atresia
- Liver flukes
- strictures
- high conjugated bilirubin (more than 50%)
- dark urine due to high conjugated bilirubin
- clay colored stoold due to absence of urobilinogen
- Normal liver enzymes but high alkaline phosphate due to the bile duct obstruction
- a yellow discoloration of the skin, mucous membranes, and the whites of
the eyes caused by increased amounts of bilirubin in the blood.